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The Detox Delusion

It’s January which means it’s detox season. Not surprisingly, the scientific evidence supporting “detox” and “cleansing” hasn’t changed since this post was originally written in January 2009:

How ineffective products treat non-existent conditions

They may line the shelves of your local pharmacy. Boxes or bottles, with some combination of “detox”, “cleanse” or “flush” in the product name. The label promises you a renewed body and better health – only seven days and $21.95 away. It’s the New Year – wouldn’t a detox from your sins of 2012 be a good idea to start the year? After all, the local naturopath offers detoxification protocols, so there must be something to it, right?

Wrong. This is a case of a legitimate medical term being turned into a marketing strategy. In the setting of real medicine, detoxification means treatments for dangerous levels of drugs, alcohol, or poisons, like heavy metals. Detoxification treatments are medical procedures that are not casually selected from a shelf or from a menu of alternative health treatments. They’re provided in hospitals when there are life-threatening issues.

So what’s with all the detox products in the drugstore?

To given the impression of science, “detoxification” is a term that has been widely embraced by alternative practitioners, and pharmacies simply want their share of the business. Anything can be a “detox” now, especially at the beginning of January: Diets, fasting, supplements, tea, homeopathy, colon flushes, scrub brushes and foot baths all mention detoxification. Let’s look at the most common product in the pharmacy: the seven- to thirty-day kits promising a whole new you. To evaluate the value of these detox kits, we need to understand the science of toxins, the nature of toxicity, and how detox kits claim to remove toxins. With this framework, it’s a simple matter to spot the pseudoscience and be a smarter consumer.

Premise One: Our bodies are accumulating toxins

The idea that we are being poisoned from within is not a new one; it’s a historical concept rooted in ideas of sympathetic magic. Called “autointoxication,” it drew a link between our bowels and other health problems. Clean out the bowels, went the theory, and you could cure any illness. Science led us to discard autointoxication by the 1900s as we gained a better understanding of anatomy, physiology, and the true cause of disease. Despite the science, however, the idea persists among the alternative practitioners, who don’t base their treatments on scientific evidence. Today’s version of autointoxication argues that some combination of food additives, gluten, salt, meat, prescription drugs, smog, vaccine ingredients, GMOs, and perhaps last night’s bottle of wine are causing a buildup of “toxins” in the body. But what is the actual “toxin” causing harm? It’s nothing more than a meaningless term that sounds scientific enough to be plausible. A uniform feature of detox kits is the failure to name the specific toxins that the kits will remove. For example Renew Life admonishes you,

In today’s toxic world, cleansing and detoxification is a necessity. Toxins enter our body daily through the air we breathe, the food we eat, and the water we drink. Over time, these toxins build up and slowly start to affect our health in a negative way. Through cleansing and detoxification, you enable your body to better process this toxic load. Reducing the toxic load in your body decreases the risk of developing chronic health problems, improves overall health and immune response, and can increase energy levels.

CleanseSMART works to cleanse and detoxify the entire body, but with focus on the body’s two main detoxification pathways – the liver and the colon.

Note the vague language. Toxins are alluded to – but not named. It sounds somewhat plausible, but is non-specific. Note that even if you’re well (and presumably toxin free?) a detox is still recommended.

The colon remains ground zero for detox advocates. They argue some sort of toxic sludge (sometimes called mucoid plaque) is accumulating in the colon, making it a breeding ground for parasites, candida (yeast) and other nastiness. Fortunately, science tells us otherwise: mucoid plaque and toxic sludge simply do not exist. It’s a made-up idea to sell detoxification kits. Ask any gastroenterologist (who look inside colons for a living) if they’ve ever seen one. There isn’t a single case that’s been documented in the medical literature. Not one.

Premise Two: Illness is the result of toxins

Marketing materials for detox kits typically describe an array of symptoms and diseases linked to toxin buildup: A few that are general enough to apply to anyone (e.g., headache, fatigue, insomnia, hunger) with a few specifics to frighten you (cancer, etc.) Which toxins cause which disease is missing, and how the toxins cause the symptoms is never actually explained. Here again we see the contrast with real science. To establish that even a single chemical can cause disease requires a significant amount of research (i.e., the entire field of epidemiology). Despite the variety of toxins that are claimed to be causing your illness, marketing claims for detox kits will uniformly fail to link toxins to specific symptoms or illnesses.

The reality is that our bodies are constantly being exposed to a huge variety of natural- and synthetic chemicals. The presence of any chemical in the body, (natural or synthetic) does not mean that it is doing harm. Many naturally-derived substances can be exceptionally toxic, and consequently the human body has evolved a remarkable system of defenses and mechanisms to defend against and remove unwanted substances. The skin, kidneys, lymphatic system, our gastrointestinal system, and most importantly, the liver make up our astounding complex and sophisticated intrinsic detoxification system.

Advocates for detox kits typically characterize the liver and kidney as acting like filters, where toxins are physically captured and retained. It’s argued that these organs to be cleaned out periodically, like you’d rinse out a sponge, or change the air filter in your car. But the reality is, the kidney and liver don’t work this way. The liver performs a series of chemical reactions to convert toxic substances into ones that can be eliminated through the bile or the kidneys. The liver is self-cleansing – toxins don’t accumulate in it, and unless you have documented liver disease, it generally functions fine. The kidney excretes waste products into the urine – otherwise the substance stays in the blood. To argue that either organ need a “cleanse” is to demonstrate a profound ignorance of human physiology, metabolism, and toxicology.

Premise Three: Detox kits remove toxins

A search of the medical literature for clinical studies of detox kits provides the following result:

No Items Found

Interpretation: There is no credible evidence to demonstrate that detox kits do anything at all. We can be comfortable concluding that marketing claims of toxin removal with detox kits are unsubstantiated. There is simply no credible evidence to support the evidence that detox kits and treatments remove toxins.

Can Detox Kits Cause Harm?

So we’ve failed to find any legitimacy behind the premises of Detox which calls for any ethical health professional to ask: If they provide no benefit, is there the potential for harm?

What exactly do these kits contain?

Contents vary, but typically contain two categories of ingredients:

A liver “booster” – typically milk thistle (Silibum marianum) If the liver can’t be wrung out and rejuvenated, can it be boosted to do a better job? Milk Thistle is the most popular product purported to “boost” the liver’s effectiveness. There are no published studies that demonstrate milk thistle has a detoxifying effect on the liver. Milk thistle has been studied in patients with alcoholic liver disease, and in patients with hepatitis B or C, and it has not been found to exhibit any meaningful effects. What this means is that there is no reason to conclude that consuming milk thistle will significantly improve your liver’s ability to function, or to remove unnamed “toxins”.

A laxative – Typically magnesium hydroxide, senna, rhubarb, cascara, etc. Laxatives are the ingredients in detox kits that give you the effect you can see (and feel). However, these ingredients can cause dehydration and electrolyte imbalances if not used carefully. Regular use of stimulant laxatives, like senna and cascara, are ill advised for most healthy adults due to the risk of dependence and electrolyte depletion. They’re among the most potent laxatives, usually used for short periods to alleviate significant constipation or to clear out your bowels before a medical procedure. With regular use, your bowel can grow accustomed to the effects of laxatives which may result in constipation once you stop using them. It’s a perfect case of the treatment causing the illness: After the detox, you get could conceivably become constipated: Time for another detox!

Side effects can continue once a detox ends. Some people experience post-detox effects like nausea and diarrhea. Advocate call these “cleansing reactions” and will assure you it’s just toxins leaving the body. A more plausible, science-based explanation is that this is a consequence of restarting the digestion process after a period of catharsis, where, depending on the extend and duration of fasting, little to no digestion occurred. It’s the same effect seen in hospitalized patients who have difficulty initially digesting food after being fed intravenously. The detox ingredients, and resulting catharsis, may irritate the colon to such an extent that it may take time to return to normal.

Weight loss is not uncommon after a detox. Unfortunately this is usually due to losses in water and possibly muscle tissue, depending on the diet followed during the program. Regardless of the weight loss, the body will move back to its pre-detox weight over time if diet and activity levels remain the same.

Conclusion

Alternative medicine ideas of detoxification have no basis in reality. There’s no published evidence detox kits have any beneficial effects. Yet, there is a real potential for these kits to do harm.

Detox kits have no place in pharmacy practice. These products reinforce faulty impressions about how the body works. They focus attention on irrelevant issues, and give consumers the impression that they can undo lifestyle decisions with a simple quick fix. Improved health isn’t found in a box of laxatives and herbs. The lifestyle implications of a poor diet, lack of exercise, smoking, lack of sleep, and drug use cannot simply be flushed away.

The beginning of January is an ideal time for pharmacists to connect with patients who may have misguided ideas about detox. Instead, focus on credible lifestyle changes that have real benefits:

Weight loss if warranted

Smoking cessation as required

Eating more fruits, vegetables and whole grains

Minimizing meats, saturated fats, and heavily processed foods

Going easy on the alcohol

Exercising regularly

It’s reasonable to conclude that any product with the words “detox” or “cleanse” in only going to be effective at cleansing your wallet of cash. If anyone suggests a detox or cleanse to you, you’d do well to ignore any other health advice they may offer.

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30 thoughts on “The Detox Delusion”

Great Blog! How in the world did the DHSA of 1994 ever get passed? I recently wrote a blog on Modern Day Snake Oil that goes into the same topic. This is really important for educating this “quick fix” pharmaceutical consumer public of ours.

Citation required? Where should I begin? Ok let’s start with milk thistle since it’s the most obvious:

Knowledgeable people take milk thistle because of its active constituent Silymarin. You can find reputable manufactures that produce milk thistle standardized at 80% Silymarin. Here is some cited research about milk thistle and its active member Silymarin.

You said:
-“There are no published studies that demonstrate milk thistle has a detoxifying effect on the liver “
-“Milk thistle has been studied in patients with alcoholic liver disease, and in patients with hepatitis B or C, and it has not been found to exhibit any meaningful effects”

I appreciate the citations provided, as they serve as a good example of how scientific data can be used by the promoters of detox kits (and detoxing in general) to give the impression that “detox” is beneficial. To start, this article is about “detox”, not the therapeutic treatment of hepatitis A, B, C or alcoholic liver disease. In fact, if you read the directions on the Cleanse Smart I described above, it specifically advises against use by anyone with “liver or gallbladder disorders, bile duct obstruction and/or bowel obstruction”. These kits are marketed at those that are otherwise well.

Having said that, even if you have hepatitis, there is no clearly established role for silymarin. The Cochrane review I linked to points out that a meta-analysis of 13 trials points out that milk thistle has no significant effect on mortality, complications of liver disease, or histology. The Agency for Healthcare Quality and Research report (which is older) makes the same conclusions.

Perhaps the role of silymarin will become more clear for the treatment of hepatitis or alcoholic liver disease if evidence emerges to demonstrate that it provides a meaningful benefit on relevant outcomes in those diseases. It does seem to have pharmacologic effects. But they need to be understood so that the overall risk and benefit is more clear. But for the purposes of a “detoxing” or “cleansing” or the use of a “detoxing kit”, which is taken short-term by those without any underlying liver disease, there is no published information whatsoever to suggest that taking milk thistle has any meaningful benefits.

The Cochrane review methodological quality was very low Scott. A study’s validity and unbiased results rest solely on this factor. I wouldn’t refer to this half ass trial as your rebuttal or basis in your claims of milk thistle.

You said:
-“To start, this article is about “detox”, not the therapeutic treatment of hepatitis A, B, C or alcoholic liver disease.”

Then why did you add this non-researched claim in your article:
-“Milk thistle has been studied in patients with alcoholic liver disease, and in patients with hepatitis B or C, and it has not been found to exhibit any meaningful effects.”

I will agree with you and the other readers that A LOT of detox manufactures have very obscure combinations of ingredients with little evidents of its therapeutic validity. But! There are some companies (that I won’t name in fear of looking like a promoter or salesmen) that do their research and provide quality/safe products.

I am extremely happy to have the DSHA act of 1994 so that I’m not forced to pay pharmaceutical companies for similar treatments. But in saying that I also believe there should be more policing of manufacturing and claims of all supplement manufactures. This would help to eliminate many of the obscure products that I mentioned earlier.

Scott, your stance in your article and in others is clearly against alternative medicine. You being a pharmacist makes that pretty apparent. Just a word of advice going forward, research thoroughly before making conclusions and try and be less biased and more objective in your blogging.

Fennel Seed
1)Bioguided isolation and identification of the nonvolatile antioxidant compounds from fennel (Foeniculum vulgare Mill.) waste. J Agric Food Chem. 2004.
A bioguided isolation of an aqueous extract of fennel waste led to the isolation of 12 major phenolic compounds. Eight antioxidant compounds were isolated and identified for the first time in fennel: 3-caffeoylquinic acid, 4-caffeoylquinic acid, 1,5-O-dicaffeoylquinic acid, rosmarinic acid, eriodictyol-7-O-rutinoside, quercetin-3-O-galactoside, kaempferol-3-O-rutinoside, and kaempferol-3-O-glucoside. The isolated compounds exhibited a strong antiradical scavenging activity, which may contribute to the interpretation of the pharmacological effects of fennel.

The claims on the lable about liver, kidney, joint, heart , etc. is indeed outlandish and should be scaled back but the research helps to reinforce that clearing excess waste(since the majority of adults are constipated by definition) and reintroducing antioxidant and immune boosting compounds exogenously can benefit a healthy individual though a process of removing toxic substances and or qualities.

I myself would not use Super Colon Cleanse as there are better products on the market but it shows you even the middle of the road supplemental cleansers have some beneficial properties.

i see a problem though. if a pharmacy just wants to get a lil piece of the alt med pie, then by extrapolation doesnt it make sense that the lines are now blurred between alt med and real med? the pharmacy and the medical industry are tacitly now saying , ” we are selling this product with our other products therefore we are kinda endorsing these as well as all our other products”?

You are very wrong about your generalization of Alternative Med. Trash talk…learn about the real history of medicine and how the AMA, FDA has been full of corruption and creating a monopoly on the Med. Industry in the west, especially the USA. There are punks like you debunking the truth from all kinds ofmedicine. You think the only real science is approved by the murdering FDA and their pimps in the patented pharmaceutical indstry.Allopathic medicine has

Allopathic Med. has its place but it is not king, though rich powerful bastards have debunked everything else and made it seem so to the public…..but the truth change american health without Obamacare that just pumps more money into mad scientists and their dopecooks!

Great article, but for a website claiming to be science based, why are you advocating a minimized meat and saturated fat intake, when both of those recommendations are not optimal for good health and are the result of cherry picked science?

You made some nice points to argue against companies trying to make money on detoxing kits.

I agree with some of your statements.

However, I am in disagreement with you on a few of your points.

You say that toxins do not build up in the liver. You are false in this statement. Talk to a gastrologist or read up on fructose intolerance. Liver failure can ultimately be the end result of a toxin build up in the liver due to the body not being able to properly process the fructose sugar ingested.

Second, I do periodically fast not from store kits.
I have done multiple day fasts from food and only on water or if I am getting drained with a headache trying to come on I will mix a tad of real salt/sea salt, lemon, and a just bit of maple syrup. Although my reasons for fasting are not for health benefits I would testify that my body does go through a detoxing process.

I personally will get acne when I fast. When a person reads up on the detoxification process you will note that toxins can be released through the skin resulting in some getting acne. I never get acne or had it in my past. It does not become a issue until I fast over a period of time,

Yes, you are right the digestion tract does shut down I hate to start eating afterward it hurts even if I slowly start because my digestion system hasn’t had to work for the time period I was fasting. I will ultimately gain more weight even though I have lost weight during my fast because my body goes into a famine feast stage.

I have known a few people who practice enemas and or colon irrigation. The tales I have heard from them have been a fascinating listen especially the ones who have received the colon irrigation procedures. They do refer to expelling a deep dark black tar substance. Is this the plaque substance you refer to not existing? I do not know. But I would think that the substance is a build up of fecal matter that is lining the walls of their colon and digestion tract and not from their daily bowel they released earlier in the day.

Yes, our bodies were created marvelously. But due to the factors of our existing world certain environmental factors do effect our bodies. Our bodies do collect toxins.

Do I agree with the mumbo jumbo on the pharmacy stores shelf more than likely not.

You are confusing the two definitions of toxin. There are toxins, substances toxic to the body, which do *not* build up in the liver, unless you have liver disease, any more than urine “builds up” in the bladder. The liver exists to remove toxins and they are then excreted. Then there are Toxins(TM), the alt-med cult’s version of the bogeyman (and constructed in exactly the same way, an agglomeration of horror stories taken out of context, like people trying to frighten their children into compliance with tales of ogres).

Alties exploit the existence of toxins to raise fears about Toxins(TM) and thus sell worthless treatments to remove them, secure in the knowledge that most people lack the critical thinking abilities to spot that if toxins genuinely did build up as alties claim then the species would have either died out or evolved a way of dealing with them (which is, of course, what happened).

“Celebrities, with a bit more vigilance and checking, we can avoid 90% of
misleading science claims. Stick this cut-out-and-keep guide to your fridge!
* IMMUNE BOOSTING: you can’t and you don’t need to.
* DETOX: your liver does this.
* SUPERFOOD: there is no such thing, just foods that are high in some nutrients.
* OXYGENATING: your lungs do this.
* CLEANSING: you shouldn’t be trying to cleanse anything other than your skin or hair.

Terrible article. Ever heard of free radicals? Unpaired electrons causing damage in the body is science. And as demonstrated by David there are in fact studies that have demonstrated the efficacy of milk thistle – mostly through the regeneration of hepatocytes leading to improved functioning of the liver and thus improved detoxification. Perhaps check pubmed and science direct for studies next time. In saying that though, many detox products available are fairly useless.

This sadly is so indicative of the typical southern-Alberta mentality of our medical practitioners. Lived in California for seven years where it was common and seen as quite ok for your MD to discuss ‘alternative medicine’ as an option. No one blinked an eye at it. Went to school in California to study alternative therapies. Several of my classmates were MDs, nurses and nurse practitioners. The ‘chip on my shoulder’ ‘holier than thou’ attitude that so obviously oozes from this article will only accomplish one thing. The writer will find himself obsolete and viewed as outdated as the general populace wakes up to the fact that there are alternatives to western medicine, western medicine by no means has a monopoly on healing and never had, and preventative medicine is much better than reactionary.

I agree 100% that detoxes are not necessary- unfortunately my parents discovered the lemonade cleanse a time ago and keep doing it. I’m concerned they’re going to have lasting effects- they lose a good amount of weight each time so they think its great. Do you have an awesome explanation that I can hand them so they’ll listen?? I gave my dad a list of do/don’t foods (sugar,processed..) and he doesn’t want to have to make anything special. The water, lemon, syrup, cayenne is too easy. :(

Did you see those detox websites where people take pictures of their poop and post it? Surely that’s the definition of too much free time on your hands.

Keep fighting the good fight, Scott. I’ve been arguing on another site with someone insisting that high doses of vitamins heal spinal cord injuries. It’s like playing a giant game of Whack-A-Mole with the whole Internet.

You and Scott belong together, two enlightened idiots sit and listen to bad science and it out to be good and badmouth good science…I tell you what I know a doctor that does jeal spinal cords and regrows cartlidge in knees, all sorts of things that mainstreem oh So called good science says cant be done. Instead they wanna drug the hell out of you fuse your spine together give you plastic or titanium kneecaps and all kinds of crap… You just go ahead and find out what the “Good Fight ” is…

“The Cochrane review methodological quality was very low.” LOL. I’ve never heard that one before! Were these claims above about some of these ingredients in the cleanses investigated in RCTs, or are they just test tube claims? I’m glad someone wrote about this, it made my day!

What happens to a water filter when you put mud in the water? Do people realize how many chemicals are EVERYWHERE – which our poor liver has to flush out. Phallates, for example, HAVE BEEN PROVEN TO ACCUMULATE. Same with Mercury, and Silver, and Lead, and Chlorine. And products, such as Chlorella, have been proven to remove Mercury from the body faster than the liver can do nautrally! Don’t you guys have logic? Do you use your brain? OR HAS ALUMINIUM ACCUMULATED IN YOUR BRAIN – this is proven too! Change the word toxin to chemicals and it will all make sense to your small brain! Why do cleaning products recommend opening the window for fresh air – so as to not expose the body to harmful chemicals. And Chemicals do build up in the body AND do cause disease. Have you also not heard of the word oxidative-stess – a scientific term. Look it up, and read the book writtern by… guess who… a scientist…. Slow Death By Rubber Duck

Oxidative-stress is an issue related to abnormal mitocondrial dysfunction that creates loads of free oxidants (a disease). Mind you, theese oxidants are also produced by our immune system to combat bacteria and inflammation within the body.

” Why do cleaning products recommend opening the window for fresh air – so as to not expose the body to harmful chemicals. And Chemicals do build up in the body AND do cause disease. ”

Yes. Open the window so you don’t get poisoned. But thats another thing than a buildup of harmful chemicals or metals in the body. Some metals build up in the body like mercury or arsenic and can cause poisoning because the body can’t effectively get rid of it. Vitamin A is just as dangerous. Our whole body is a chemical process.
And while Chlorella may be good for you in a nurtients kind of way there is no conclusive and/or peer-reviewed papers suggesting that it removes mercury from the blood (the liver) or nervous system.

While Rick Smith and Bruce Lourie are prominent enviromentalists and are experts on how pollution spreads in the food chain and enviroment they are not doctors with human toxology as expertise..I took this up because it seemed that you tried to link their book to what you have typed above…yes they are scientists, but there are many fields of science…